Introduction to research in Epidemiological research

Introduction to research
methodology
1

Learning objectives
 After completing this chapter, the student should be
able to:
• Define research in general and health systems research
in particular
• Enumerate the characteristics of research
• Identify the different types of research
• List the essential features of health systems research
• Describe the broad divisions (steps) involved in the
research process
• Explain the roles of research in development
2

Introduction
• Research in the context of public health aims to
provide all aspects of information necessary for
planning and the effective implementation of a health
system.
• For all communities, whether affluent or poor, health
research is the top priority.
• The research questions are formidable: how to join
with policy makers and communities in assessing
priority needs, planning, financing and implementing
programs, and evaluating them in terms of coverage,
efficiency and effectiveness.
3

Definition of Research
• Research is the systematic process of collecting
analyzing and interpreting information to increase
our understanding of a phenomenon under study.
• Research is the systematic collection, analysis and
interpretation of data to answer a certain question or
solve a problem.
4

Health research
• It provides the basic information on the state of
health and disease of the population.
• Health research is the application of principles of
research on health. It is the generation of new
knowledge using scientific method to identify and
deal with health problems
• It attempts to devise better approaches to health care
for the individual and the community. 5

Health research…
• In most cases, health research has been divided into three
overlapping groups.
• Essential health research: Consists of activities to define
the health problems of a given community, to measure
their importance and to assure the quality of activities to
deal with them.
• Much of this research comes within the category of health
service research but there will be elements of clinical
research and dev’t of technology 6

Health research…
• Clinical research: In its widest sense, this group of
topics ranges from studies of the prevention and
diagnosis of diseases through new methods of
treatment to problems of care and rehabilitation.
• The sophistication will vary from problem to problem
and there will be overlap with the fields of essential
and biomedical research.
7

Health research…
• Biomedical research: It is the most basic part
of health research which demands more
resources, facilities and skilled investigators.
• The results of biomedical research are more
often of universal importance and thus of
general significance.
8

Health Systems Research
• It is ultimately concerned with improving the health of
people and communities, by enhancing the efficiency
and effectiveness of the health system as an integral
part the overall process of socio-economic
development, with full involvement of all partners.
• HSR is undertaken primarily to provide information to
support decision-making at all levels that can improve
the functioning of the health system.
9

Health Systems Research...
• Health system may be described as:
– A set of cultural beliefs about health and illness
that forms the basis for health-seeking and health-
promoting behavior.
– The institutional arrangements within which that
behavior occurs; and
– The socioeconomic (political) physical context for
those beliefs and institutions 10

• Health System- all public and private
sectors/institutions which directly influence and
support the health of people, embedded in the
wider environmental context (geographical, socio-
economic, cultural, political, demographic,
epidemiological factors).
11

• The institutional arrangements within which the
health-seeking and health-promoting behavior occurs
may include:
1.The individual, family and the community
2. Health care services- public vs private
3. Health related sectors -education, agriculture etc.
4. The international sector, including bilateral and
multilateral donor agencies 12

• Each of these definitions emphasize the
multidisciplinary nature of health research, health
systems research and health services research.
• Health services research, for example, has been
described as ‘a space within which disciplines can
meet’
13

Essential features of HSR
• HSR should focus on priority problems.
• It should be action oriented
• An integrated multidisciplinary approach is required(
approaches from many disciplines)
• The research should be participatory in nature
(from policy makers to community members)
14

Essential features of HSR…
• Research must be timely.
• Emphasis should be placed on comparatively simple,
short-term research designs that are likely to yield
practical results
NB. The principle of cost-effectiveness is important in
the selection of research projects.
15

HSR…
• Results should be presented in formats most useful for
administrators, decision makers and the community.
- A clear presentation of results with a summary of the
major findings adapted to the interests of the party
being targeted by the report.
- Honest discussion of practical methodological
problems that could have affected the findings.
16

HSR…
• Alternative courses of action that could follow from
the results and the advantages and drawbacks of each.
• An HSR project should not stop at finding answers
to the research questions posed, but include an
assessment of what decisions have been made based on
the results of the study. This is the ability of research
findings to influence policy, improve services and
contribution to the betterment of health.
17

Types of research
• Research is a systematic search for information and
new knowledge.
• It covers topics in every field of science and
perceptions of its scope and activities are unlimited.
18

Types of research…
Philosophical approach:
1.Empirical:
 Based upon observation and experience
2. Theoretical:
 Based on theory and abstraction
HSR mainly follows empirical approach
19

Types of research...
functionally
1. Basic Research-is necessary to generate new knowledge
and technologies to deal with major unresolved health
problems.
• Driven by the scientist’s curiosity or interest in a scientific
question. ‘acquire knowledge for knowledge’s sake.’
2. Applied Research- is problem-oriented, and is directed
towards the solution of an existing problem.
• Designed to solve practical problems of the real world.
20

Based on Approaches of Research
(strategy of inquiry)
1. Quantitative research-to determine the extent of a
problem, issue, or phenomenon.
2. Qualitative research- to explore the nature of a
problem, issue, or phenomenon
21

Quantitative Research
 Quantitative research is the systematic and scientific
investigation of quantitative properties and
phenomena and their relationships.
 The process of measurement is central to
quantitative research because it provides the
fundamental connection between empirical
observation and mathematical expression of an
attribute. 22

Quantitative Research …
• Quantitative researchers favor methods such as
surveys and experiments, and will attempt to test
hypotheses or statements with a view to infer from
the particular to the general.
• This approach typically concentrates on measuring
or counting and involves collecting and analyzing
numerical data and applying statistical tests.
23

Qualitative research
 Qualitative research involves studies that do not
attempt to quantify their results through statistical
summary or analysis.
 Qualitative research seeks to describe various aspects
about behavior and other factors studied in the social
sciences and humanities.
 In qualitative research, data are often in the form of
descriptions, not numbers.
24

Qualitative research …
• It is thus a type of empirical inquiry that entails
purposive sampling for gathering data.
• It typically involves in-depth interviews, focus group
discussions and observations without formal
measurement.
• A case study, which is an in-depth examination of one
person, is a form of qualitative research.
25

Qualitative research …
 It is concerned with the social aspects of our world
and seeks to answer questions about:
• Why people behave the way they do.
• How opinions and attitudes are formed.
• How people are affected by the events that go on
around them.
• How and why cultures have developed in the way
they have. 26

Qualitative vs. Quantitative
 Why?
 How?
 Understanding
behavior/insight
 Non-numeric
 Subjective
 Non-generalizable
 Small sample
 Generate hypothesis
 How many? How much?
How often? Why?
 Quantification/statistical
analysis
 Numeric
 Objective
 Generalizable
 Large sample
 Test hypothesis
27

Based on Research Purpose
• The three general purposes are:
 Exploration
 Description and
 Explanation
• A given study can have more than one of these
purposes
28

Descriptive research
 Is conducted to describe some phenomenon
 Attempts to describe systematically a situation,
problem, phenomenon, service, etc.
 It provides detailed numerical description of
relatively few dimensions of a well defined subject.
 Descriptive research seeks information about isolated
variables
29

Explanatory research /analytic
research
 Attempts to seek answers to research hypotheses or
problems
 Explain factors associated with a particular phenomenon
 Answer cause - effect questions or make projections into
the future
 Examines the relationships among variables
 “Why” and “what will be”
30

Explanatory research …
 Seeking to explain the reasons behind a particular
occurrence by discovering causal relationships.
 Is more difficult than descriptive research.
 It relies heavily on multivariate analyses and model-
building techniques based on sound theoretical
framework.
31

Exploratory Research:
 Usually conducted when relatively little is known
about the phenomenon under study
 The subject of study is relatively new and unstudied
 To gain familiarity, in-sight, ideas; an area where
little is known
 The researcher explores the topic in order to become
familiar with it and to gain ideas and knowledge
about it.
32

Characteristics of research
• It demands a clear statement of the problem
• It requires a clear objective and plan
• It builds on existing data, using both positive and negative
findings
• New data should be collected as required and be organized
in such a way that they answer the research questions
33

Evidence-based practice
 Why should we be interested in research?
• In the past, decisions about methods of diagnosis and
treatment were based on authority.
• The opinion of the eminent practitioner, based on
experience and the earlier authority of others, was the
main source of information.
34

Evidence-based practice …
As health care became more scientific,
practitioners are encouraged to use scientific
data as the source of their decisions about
methods of diagnosis and treatment.
We are in the era of evidence-based medicine
35

The research process
 The research process is similar to undertaking a
journey.
 For a research journey there are two important
decisions to make:
1. What you want to find out about or what research
questions (problems) you want to find answers to;
2. How to go about finding their answers.
36

The research process
 There are practical steps through which you must
pass in your research journey in order to find
answers to your research questions.
 The path to finding answers to your research
questions constitutes research methodology.
37

The research process…
• At each operational step in the research process you
are required to choose from a multiplicity of methods,
procedures and models of research methodology
which will help you to best achieve your objectives.
38

The research process…
• Main components of any research work
I. Preparing a research proposal
II. Fieldwork (i.e., data collection)
III. Analyzing data and preparing a research report
• N.B: The roles of health managers and the community
should be identified in the various phases of the
research process.
39

Learning objectives
• After completing this chapter, you should be
able to:
 Describe the principles underlying whether a problem
situation is researchable.
 List the criteria for selecting a research topic
42

Introduction
• Formulation of the research proposal is the major task
in the process of developing a research project.
• The proposal draws on all the preparatory steps of the
research process and pulls them together in a
document describing the rationale and the
methodology proposed for research
43

Introduction…
• The proposal is a basis for approval and funding.
After approval, the proposal is used as a blueprint
during implementation of the project.
• It should be noted that development of a research
proposal is often a cyclical process.
• The process is not always linear. It is a usual practice
to go up and down on the developed proposal and
make the necessary revisions. 44

Topic selection/problem
identification
• If the answer to the research question is obvious, we
are dealing with a management problem that may be
solved without further research.
• Defining the problem is the first step and one of the
most difficult in research undertaking.
45

Topic selection/problem
identification
The sources of a research problem could be
– Observations
– Experts
– Literature reviews
– Professional conferences
– Problems
46

Problem identification…
• The choice of a research topic is influenced by a
number of factors
research aims at addressing society problem
testing or constructing a scientific theory
the researcher’s personal interests, ability
 resources available
47

• Researchers’ personal interests and experience
can play a significant role in the selection of
topic
• The availability of relevant data also dictates
whether a topic can be studied adequately.
48

When does a research problem
exists?
 A potential research situation arises when three
conditions exist:
1. A perceived discrepancy exists between what is and
what should be.
2. A question exists about why there is a discrepancy.
3. At least two possible and plausible answers exist to the
question.
49

Example
• Problem situation: In district “Z” (population 150,000)
there are 2 health centers, 1 hospital and 15 health
stations and all of them function smoothly. However, at
the end of the year it was found that the EPI coverage was
only 25%.
• Discrepancy :Although district “Z” had 100%
availability of health services and at least 80% of the
children should have had full vaccinations but the EPI
coverage was only 25% as seen above.
50

Example…
Problem question: What factors influence the low EPI
coverage in district “Z”?
Possible answers:
• Mothers might have problems for not attending in
the EPI sessions, The MCH, EPI, OPD, CDD, etc…
programs might not have been integrated, The follow
up of defaulting children might not be effective etc.
Thus, the above problem situation is researchable.
51

Identification and Prioritization of
Research Problem
 First bear in mind about the problem to be studied
 The problem should be researchable
 Should contribute to new knowledge
 There must be appropriate method available to
investigate the problem
 Consider participants, ethical implication, time,
budget and other necessary resource constraints
52

Criteria for selecting a research
topic
• Problem that is proposed for research has to be
judged according to certain guidelines or criteria.
• There may be several ideas to choose from.
• Before deciding on a research topic, each proposed
topic must be compared with all other options.
53

topic…
• The selection and analysis of the problem for research
should involve those who are responsible for the
health status of the community. This would include
managers in the health services, health-care workers,
and community leaders, as well as researchers.
54

topic…
1. Relevance
2. Avoidance of duplication
3. Urgency of data needed (timeliness)
4. Political acceptability of study
5. Feasibility of study
6. Applicability of results and recommendations
7. Ethical acceptability
55

Relevance
The topic should be a priority problem.
Questions to be asked:
• How large or widespread is the problem?
• Who is affected?
• How severe is the problem?
• Try to think of serious health problems that affect a
great number of people or the most serious problems
that are faced by managers in the area of your work.
56

Relevance…
• Ensure that your study adds to the existing body of
knowledge, bridges current gaps and is useful in
policy formulation. This will help you to sustain
interest in the study.
• All the community members and local managers have
an interest in solving the problem.
57

Avoidance of duplication
Before you decide to carry out a study, Answer:
• Does the suggested topic has been investigated before,
within the proposed study area or in another area with
similar conditions ?
• If the topic has been researched, the results should be
reviewed to explore whether major questions that
deserve further investigation remain unanswered. If
not, another topic should be chosen.
58

Urgency of data needed (timeliness)
• How urgently are the results needed for making a
decision or developing interventions at various levels
(from community to policy)?
• Consider which research should be done first and
which can be done later.
59

Political acceptability
 In general it is advisable to research a topic that has the
interest and support of the local/national authorities.
 This will increase the chance that the results of the
study will be implemented.
 Under certain circumstances, however, you may feel
that a study is required to show that the government’s
policy needs adjustment.
60

Feasibility
• Look at the project you are proposing and consider
the complexity of the problem and the resources you
will require to conduct the study.
• Attention should be given first to manpower, time,
equipment and money that are locally available.
• Finally, explore the possibility of obtaining technical
and financial assistance from external sources.
61

Applicability of possible results/recommendations
 Is it likely that the recommendations from the study will be
applied?
 This will depend on:
 Management capability
 Willingness of the authorities and
Availability of resources for implementation.
 Likewise, the opinion of the potential clients and of
responsible staff will influence the implementation of
recommendations. 62

Ethical acceptability
 We should always consider the possibility that we may
inflict harm on others while carrying out research.
 Review the following
How acceptable is the research to those who will be
studied?
Can informed consent be obtained from the research
subjects?
Will the condition of the subjects be taken into account?
63

Ethical acceptability…
E.g, if individuals are identified during the study who
require treatment, will this treatment be given? What
if such treatment interferes with your study results?
Will the results be shared with those who are being
studied?
Will the results be helpful in improving the lives or
health of those studied?
64

ANALYSIS AND STATEMENT
OF THE PROBLEM
65

Learning objectives
After completing this chapter, the student should be
able to:
1. Describe the advantages of a systematic analysis of a
problem
2. Describe the importance of a clear statement of a
problem
3. Enumerate the points that should be included in the
statement of a problem
66

Analyzing the Problem
 A systematic analysis of the problem, completed jointly by
the researchers, health workers, managers and community
representatives, is a very crucial step in designing the
research because it:
Enables those concerned to pool their knowledge of the
problem,
Clarifies the problem and the possible factors that may be
contributing to it, and
Facilitate decisions concerning the focus and scope of the
research. 67

Steps to analyze the problem
Step 1: Clarify the viewpoints of managers, health
care workers and researchers in relation to the
problem.
• During initial discussions with managers and
health care workers who are involved in the
problem area, clarify the issues by listing all the
problems in the area of concern, as they perceive
them. 68

Steps to analyze the problem...
Step 2: Further specify and describe the core problem.
You should then try to identify the core problem and
quantify it.
The nature of the problem; the discrepancy between
‘what is’ and what you prefer the situation to be
The distribution of the problem - who is affected,
when, where and
The size and intensity of the problem - is it widespread,
how severe is it, what are its consequences (such as
disability, death, waste of resources)?
69

 Step 3:Analyse the problem.
• Identify factors that may have contributed to the
problem.
• Clarify the relationship between the problem and
contributing factors. Preferably using diagrams.
70

Step 3 ….
How a problem is analyzed?
• Write down the core problem
• Brainstorm on possible causes or factors contributing to
the problem.
• Identify further contributing factors.
• Attempt to organise related factors together into larger
categories, and develop your final draft of the diagram.
71

72
Example; Analyzing a problem, predisposing factors causing a high defaulter rate
among Tuberculosis patients.

Formulating the problem statement
• After identifying, selecting and analyzing the problem,
the next major section in a research proposal is
“statement of the problem”
• Why is it important to state and define the problem
well?
• Because clear statement of the problem:
√ Is the foundation for the further development of the
research proposal (research objectives, methodology,
work plan, budget, etc.) 73

Formulating the problem statement…
√ Makes it easier to find information and reports of
similar studies from which your own study design can
benefit.
√ Enables you to systematically point out why the
proposed research on the problem should be
undertaken and what you hope to achieve with the
study results.
74

Formulating the problem statement…
 Is the foundation for the further development of the
research proposal (research objectives, methodology,
work plan, etc)
 This is important to highlight when you present your
project to community members, health staff, relevant
ministries and donor agencies who need to support
your study or give their consent.
75

Points that need to be considered for
justifying the selected research problem
Health problem selected to be studied has to be justified in
terms of its:
• Being a current and existing problem which needs solution
• Being a widely spread problem affecting a target population
• Effects on the health service programmes
• Being a problem which concerns the planners, policy
makers and the communities at large.
76

What information should be included in
the statement of the problem?
1. A brief description of socio-economic and cultural
characteristics and an overview of health status and
the health-care system in the country/district as far
as these are relevant to the problem.
 Include a few illustrative statistics, if available, to
help describe the context in which the problem
occurs.
77

What Information ….
2. A concise description of the nature of the problem (the
discrepancy between what is and what should be) and of
the size, distribution and severity of the problem (who is
affected, where, since when, and what are the
consequences for those affected and for the services).
3. An analysis of the major factors that may influence the
problem and a discussion of why certain factors need
more investigation if the problem is to be fully
understood.
78

What Information ….
4. A brief description of any solutions to the problem that
have been tried in the past, how well they have worked,
and why further research is needed (justification for your
study).
5. A description of the type of information expected to
result from the project and how this information will be
used to help solve the problem.
6. If necessary, a short list of definitions of crucial concepts
used in the statement of the problem can be added.
79

Literature Review
• After completing this chapter, the student should
be able to:
• Describe the reasons for reviewing available literature and
other information during the preparation of a research
proposal.
• Describe the resources that are available for carrying out such
a review.
• Describe methods of citation
81

Literature Review
• In the terms of a literature review, "the literature"
means the works you consult in order to understand
and investigate your research problem.
• It is the systematic analysis and interpretation of
available information.
31/12/2008 82

31/12/2008 83
Literature Review …
• Comprehensive examination of extant research on a
particular topic.
• A description or account of the literature that has
relevant to a particular field or topic.
• Not necessarily an analysis (review) of the sources, but
specifies which literature makes significant
contributions to the understanding of the topic.

Uses/purposes of literature review
• It prevents from duplicating work that has been done
before
• It gives a familiarity with the various types of design,
procedures and analysis methods that might be used
in the study.
• It helps to find out what others have learned and
reported on the topic.
31/12/2008 84

Uses/purposes …
• It makes researchers aware the state of the art and the
extent of research on the topic as well as current
limitations
• It should provide you with convincing arguments for
why your particular research project is needed
31/12/2008 85

What are the possible sources of
information?
• Individuals, groups, and organisations;
• Published information (books, articles, indexes,
abstract journals)
• Unpublished information (other research proposals in
related fields, reports, records, computer data bases)
31/12/2008 86

Some examples of resources where information
could be obtained are:
• Clinic and hospital based data from routine activity
statistics
• Local surveys, annual reports
• Scientific conferences
• Statistics issued at region and district levels
• Articles from national and international journals
• Internet
• documentation, reports, and raw data from the MOH,
Central Statistical Offices, NGOs, etc.
87

How do you write literature review in your
proposal?
 Three ways of organizing the information
• From broader to narrow specific aspects
• From global to local situation of the problem
• From past to present situation of the issue depending
on the purpose of the study & type of the problem
31/12/2008 88

Methods of citation in preparing
literature review
1. The Vancouver system
2. The Harvard system
31/12/2008 89

Methods of citation…
Vancouver system
• For an article
Author (s)’ Surname followed by initials. Title of
article. Name of Journal. Year ,Volume, (number) :
page number of article .
E.g.1. Louria DB. Emerging- and re-emerging
infections: The societal variables . International
Journal of infectious Disease. 1996, 1(2):59-62.
31/12/2008 90

For a book
Author(s)’ Last name first. Title of book. Edition,
Place: publisher, Year: number of page in the
book.
2. Abramson JH. Survey methods in community
medicine.2nded. Edinburgh: Churchill
Livingstone,1979:229
31/12/2008 91

Harvard system
• The references at the end of the proposal should be
listed in alphabetical order
• E.g. Abramson JH(1990)4th ed. Survey methods in
community medicine .Edinburgh: Churchill
Livingstone
31/12/2008 92

Formulating of a Research objective
• A research objective is a statement that clearly
depicts the goal to be achieved by a research
project.
• The objectives of a research project summarize
what is to be achieved by the study.
• Objectives should be
 simple (not complex),
 specific (not vague),
stated in advance (not after the research is done),
and
stated using “action verbs” that are specific
enough to be measured.

Why should research objectives be
developed?
The formulation of objectives will help you to:
• Focus the study (narrowing it down to essentials);
• Avoid the collection of data which are not strictly
necessary for understanding and solving the
problem you have identified (to establish the
limits of the study); and
• Organize the study in clearly defined parts or
phases.

When should the objectives of a
research project be prepared?
• The objectives should be written after the
statement of the problem is developed but …
• Before the methodology for the study is planned

Characteristics of good objectives
• Logical and coherent
• Feasible
• Realistic, considering local conditions
• Defined in operational terms that can be
measured
• Phrased to clearly meet the purpose of the study

How should objectives be stated?
Objectives should be stated using “action verbs”
that are specific enough to be measured:
Examples: To determine …, To compare…, To
verify…, To calculate…, To describe…, etc.
Do not use vague non-action verbs such as:
• To appreciate … To understand… To believe

Research objectives can be stated
as:
• Questions: “The objectives of this study are to
answer the following questions …”
• Positive sentence: “The objectives of this study
are to determine …”
descriptive or exploratory study
• Hypothesis: “The objective of this study is to
verify the following hypothesis...”
Analytic study
.

Types of Research Objectives
 General objective and
specific objectives.
• The general and specific objectives are logically
connected to each other and the specific
objectives are commonly considered as smaller
portions of the general objectives.

Objectives …
The General Objective:
 States in general terms what is to be accomplished
by the research project and why.
 Summarizes what is to be achieved by the study
 Should be clearly related to the statement of the
problem

Objectives …
Specific Objectives
• The specific research objectives state in greater
detail the specific aims of the research project.
• Breaking down what is to be accomplished into
smaller logical components.
• Specific objectives should systematically address
the various aspects of the problem as defined
under ‘Statement of the Problem’ and the key
factors that are assumed to influence or cause
the problem.

Objectives …
Specific Objectives
 Focus the study on the essentials
 Direct the design of the investigation
 Orient collection, analysis and interpretation of
the data

Main components of any research
work
I. Preparing a research proposal
II. Fieldwork (i.e., data collection)
III. Analyzing data and preparing a research report

Research proposal
• A research proposal is a document that presents
a plan for a project to reviewers for evaluation.
• Its purpose is to convince reviewers that you, the
researcher, are capable of successfully conducting
the proposed research project.
• Reviewers have more confidence that planned
project will be successfully completed if the
proposal is well written and organized, and if you
demonstrate careful planning.

Research proposal …
• He term "research proposal" indicates that a
specific course of action will be followed.
• The objective in writing a proposal is to describe
what you will do, why it should be done, how
you will do it and what you expect will result.

The written proposal:
Forces the students to clarify their thoughts and
to think about all aspects of the study
Is a necessary guide if a team is working on the
research
Is essential in order to get the institution’s ethical
approval
 Is an essential component submitted for funding.

Parts of proposal
• Title
• Summary/ abstract
• Introduction/background
• Statement of the problem
• Literature review
• Significant of the study
• Objective
• Method and materials

Parts of proposal …
• Work plan
• Budget breakdown
• Reference
• Annex
Dummy table
Questionnaire

Introduction to research in Epidemiological research

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